Prospective Comparison of Short vs Long Chest Tube Water Seal Trial for Traumatic Pneumothorax

Tube thoracostomy is a frequent intervention for trauma patients, yet there is insufficient evidence to guide management after placement. This study compared a short (6 ± 2 hours) vs a long (24 ± 2 hours) water seal trial (WST) before chest tube (CT) removal in patients with traumatic pneumothorax.

A prospective (July 2020 to December 2022), multicenter review involving 25 trauma centers was conducted. Patients aged 18 years or older with traumatic pneumothorax undergoing WST were included. The primary outcome was successful CT removal after WST without the need for reinsertion. Secondary outcomes were reinsertion and duration of CT, number of chest radiographs (CXRs) after CT removal, and hospital length of stay (LOS).

Of the 1,394 included patients, 328 (27.4%) underwent short WST and 1,012 (72.6%) long WST. CTs were successfully removed among 280 (73.3%) in short and 694 (68.6%) in long WST (p = 0.250). Patients undergoing short WSTs had fewer CT reinsertions (n = 24 [6.3%] vs n = 98 [9.7%], p = 0.01), lower CT duration (3 [2 to 5] vs 4 [3 to 7] days, p < 0.001), fewer CXRs (2 [1 to 3] vs 2 [1 to 5], p < 0.001), and shorter LOS (7 [4 to 15] vs 9 [5 to 17] days, p < 0.001).

This multicenter study demonstrated no significant difference between short and long WST duration with regard to successful CT removal. Short WSTs were associated with fewer adverse events, fewer CXRs, shorter CT duration, and shorter LOS.